MLLA Membership Application

Make check payable to MLLA and mail to:

MLLA
7070 Terrell St
Waterford, MI 48329

Please send the following information with your payment:

First and Last Name ___________________________________________________

Additional Name (if applicable) ___________________________________________

Lake Address __________________________________________________________

Mailing Address _______________________________________________________
(if different from above)
Phone Number(s) ___________________________________________________________

E-mail Address ________________________________________________________

Membership Dues ($45 annually): _____________________

Invasive Species Fund Donation: _____________________

Fireworks Donation:                   _____________________

Total Enclosed:                                _____________________